Current concepts in tibial plateau fracture management: A Spanish Orthopaedic Trauma Association review

Abstract

This article summarizes a symposium on topics regarding the current management of tibial plateau fractures presented by the Spanish Orthopaedic Trauma Association as a guest nation society at the Orthopaedic Trauma Association Annual Meeting in October 2023 in Seattle, Washington. These topics include staged treatment strategies, surgical planning, fracture classification, and factors influencing weight bearing. A staged protocol for treating high-energy fractures of the proximal tibia using spanning external fixation with quadrangular configuration is a simple and reproducible way to apply the device and reduce and span these fractures. Multicolumnar fractures can behave differently based on their categorization using the main deformity direction concept, defined as a theoretical vector representing the global displacement or deformity of the columns in a specific direction, and this can help surgeons decide on the definitive treatment. With the classification of columnar involvement and their variants, surgeons can use computed tomography scans to formulate solutions to approach and fix individual fracture patterns. Finally, a finite element analysis may inform the surgeon's decision for immediate weight bearing of a split plateau fracture after fixation with locking screw plates or cannulated screws.